Bellanger Martine M, Zhou Ke, Lelièvre Sophie A
Scientific Direction for Translational Research, Integrated Center for Oncology (ICO), Angers, France.
Front Med (Lausanne). 2022 Apr 4;9:826776. doi: 10.3389/fmed.2022.826776. eCollection 2022.
The primary prevention of non-communicable diseases is one of the most challenging and exciting aspects of medicine and primary care this century. For cancer, it is an urgent matter in light of the increasing burden of the disease among younger people and the higher frequency of more aggressive forms of the disease for all ages. Most chronic disorders result from the influence of the environment on the expression of genes within an individual. The environment at-large encompasses lifestyle (including nutrition), and chemical/physical and social exposures. In cancer, the interaction between the (epi)genetic makeup of an individual and a multiplicity of environmental risk and protecting factors is considered key to disease onset. Thus, like for precision therapy developed for patients, personalized or precision prevention is envisioned for individuals at risk. Prevention means identifying people at higher risk and intervening to reduce the risk. It requires biological markers of risk and non-aggressive preventive actions for the individual, but it also involves acting on the environment and the community. Social scientists are considering micro (individual/family), meso (community), and macro (country population) levels of care to illustrate that problems and solutions exist on different scales. Ideally, the design of interventions in prevention should integrate all these levels. In this perspective article, using the example of breast cancer, we are discussing challenges and possible solutions for a multidisciplinary community of scientists, primary health care practitioners and citizens to develop a holistic approach of primary prevention, keeping in mind equitable access to care.
非传染性疾病的一级预防是本世纪医学和初级保健中最具挑战性和最令人兴奋的方面之一。对于癌症而言，鉴于该疾病在年轻人中的负担日益加重，且在所有年龄段中侵袭性更强的癌症形式更为常见，这是一个紧迫的问题。大多数慢性疾病是由环境对个体内基因表达的影响导致的。总体环境包括生活方式（包括营养）以及化学/物理和社会暴露。在癌症中，个体的（表观）基因构成与多种环境风险和保护因素之间的相互作用被认为是疾病发生的关键。因此，就像为患者开发精准治疗一样，也为有风险的个体设想了个性化或精准预防。预防意味着识别高风险人群并进行干预以降低风险。这需要个体的风险生物标志物和非侵入性预防措施，但也涉及对环境和社区采取行动。社会科学家正在考虑微观（个体/家庭）、中观（社区）和宏观（国家人口）层面的护理，以说明问题和解决方案存在于不同规模上。理想情况下，预防干预措施的设计应整合所有这些层面。在这篇观点文章中，我们以乳腺癌为例，讨论了科学家、初级卫生保健从业者和公民组成的多学科群体在制定全面的一级预防方法时所面临的挑战和可能的解决方案，同时牢记公平获得护理的问题。
